By carefully following the protocol, reproducible and robust data can be easily obtained. It is critical to strictly adhere to one's customized inoculum preparation protocol for experiments to be compared to one each other. It is also important to properly handle mice during the infection procedure. Be sure to place mice into an anesthesia chamber devoid of isoflurane. Mice will panic if they are placed into a chamber that has been pre-filled with isoflurane and may experience excess stress, which can possibly compromise experimental results. After securing the container lid, slowly introduce isoflurane by incrementally increasing its concentration from 0% to 4% (v/v); hastily administering isoflurane can also cause mice to panic. Once the mice become unconscious, reduce the isoflurane concentration to 2 - 3% (v/v) and allow them to remain in the chamber for an additional few minutes. At this point, mice are ready to be infected (Figure 1).
Remove a mouse from the anesthesia chamber and suspend it by its top incisors to allow access to the tongue (Figure 2). Use blunt-ended forceps to gently pull out the tongue (Figure 3) then transfer the forceps-held tongue to a sterile, gloved fingers (Figure 4) to prevent trauma to the mouse's tongue. With the tongue still outside the mouth, transfer the 50-µL inoculum to the oropharynx (Figure 5). Here, it is very important to only deliver liquid by pipetting to the first stop on the micropipette. Continuing to the second stop can introduce a large bubble into the inoculum that interferes with the infection.
Once the infection is complete, there are a myriad of options for testing mice. For pathogenesis studies, one can compare uninfected to infected tissue (Figure 6). If analyzing the effectiveness of novel therapeutics, one can remove the lungs and have them sectioned and stained. This can be done at one time point or at multiple time points to show disease progression (Figure 7).
Another option is to assess the bacterial burden in the lungs of infected mice. This is done by removing the lungs, transferring to a vial containing a known volume of sterile PBS, then homogenizing with a tissue homogenizer (rinsing between each sample to prevent cross contamination). Plating serial dilutions of the lung homogenate on nutrient-rich agar allows for calculating the CFUs/mL for each lung homogenate and subsequently CFUs/mg lung tissue (Figure 8). This, too can be done at one time point or at multiple time points to show disease progression.
There are countless other assays that can be performed, including cytokine analyses (Figure 9), sepsis biomarkers by iSTAT (Figure 10), flow cytometry to investigate cell surface markers, cellular profiling, RNAseq, etc.

Figure 1: Determining LD100. It is necessary to infect mice with various inocula concentrations to determine the LD100. Here, the inoculum 2 × 108 CFUs/mouse is too high, 5 × 107 and 2 × 107 are too low, and 1 × 108 is just right.

Figure 2: Hang mice by top incisors. After the mice are anesthetized, remove one mouse from the induction chamber, (A) use forceps to pull out a loop of string secured 20 - 30 cm above the work surface, (B) move the string behind the mouse's top incisors, (C) ensure the string is secured behind top incisors, and (D) let the mouse hang by its top incisors on the loop of string.

Figure 3: Pull tongue out of mouth with forceps and transfer grip to gloved fingers. After hanging the mouse by its top incisors, (A) use forceps to gently grasp the mouse's tongue, (B) gently pull out the tongue, (C) carefully transfer the tongue from forceps to gloved fingers to prevent trauma to the mouse's tongue, and (D) hold the tongue in place with gloved fingers. Be sure to apply enough pressure to prevent the tongue from slipping back into the mouth but not so much pressure that trauma ensues. The tongue should be held outside of the moth and to the side to allow for micropipette access in the next step. At this point, the mouse is ready for infection.

Figure 4: Infect the mouse. Maintaining the tongue outside the mouth, use a micropipette to transfer the 50-µL inoculum to the oropharynx. Place the pipet tip inside the mouth at the back of the tongue and dispense the bacterial suspension, only going to the first top on the micropipette; do not go to the second stop as this can introduce a large bubble into the inoculum that can interfere with complete aspiration.

Figure 5: Micrograph of healthy (uninfected) vs infected lung tissue. Hematoxylin and eosin (H&E) staining of lung sections before and after oropharyngeal aspiration of A. baumannii, which recapitulates the route of ventilator-associated pneumonia (VAP), resulting in death typically within 1 - 3 days and substantial alveolar inflammation as seen here.

Figure 6: Assess bacterial burden; reprinted and modified with permission14. After infecting mice, remove lungs by dissection following successful euthanasia in compliance with the applicable IACUC protocol. Collect the mass of the lung tissue, transfer to a vial containing a known volume (2 - 5 mL) of sterile PBS, then homogenize with a tissue homogenizer. Be sure to rinse the homogenizer with ethanol and sterile PBS in between each sample to prevent cross contamination. Perform serial dilutions of the lung homogenate and plate various dilutions on nutrient-rich agar and incubate appropriately for the chosen pathogen. Calculate the CFUs/mL for each lung homogenate based on CFUs/plate × dilution, and then divide by the mg lung tissue/mL lung homogenate. This can be done at one time point or at multiple time points to show disease progression. Medians are displayed with error bars representing interquartile ranges. *p <0.05 Treated vs. Untreated group.

Figure 7: Micrograph of infected lung tissue, untreated vs treated; reprinted and modified with permission14. After infecting mice, remove lungs by dissection following successful euthanasia in compliance with the applicable IACUC protocol. Appropriately preserve the tissue (e.g., immersed in Optimal Cutting Temperature gel and frozen at -80 °C) then send to pathology lab or other proficient individual for sectioning and staining. This can be done at one time point or at multiple time points to show disease progression.

Figure 8: Cytokine analysis; reprinted and modified with permission14. To analyze circulating cytokines, procure sufficient blood (e.g., 50 µL via tail nicking), allow to coagulate for 30 min at room temperature, centrifuge at 1,000 × g for 10 min at 4 °C, and collect serum supernatant. The serum can then be analyzed by Luminex multiplex for cytokines. This can be done at one time point or at multiple time points to show disease progression. Medians are displayed with error bars representing interquartile ranges. *p <0.05 treated vs. untreated group at same time-point.

Figure 9: Sepsis biomarkers; reprinted and modified with permission14. To analyze sepsis biomarkers, procure 75 µL blood (e.g., via tail nicking) and quickly transfer to an iSTAT cartridge that tests for desired analytes. This can be done at one time point or at multiple time points to show disease progression. Medians are displayed with error bars representing interquartile ranges. *p <0.05 treated vs. untreated group at same time-point.